Matrix router for surgical ablation

ABSTRACT

A matrix router with frequency switching is provided having an energy source electrically connected to a plurality of interface ports. A switching device is provided between the energy source and the plurality of switches. One of the plurality of interface ports includes a paired electrode interface port for the connection of a paired electrode device thereto. The paired electrode device has a first pair of opposed electrodes and a second pair of opposed electrodes for clamping on tissue. When the paired electrode device is operably connected to the paired electrode interface port and actuated, the switching device alternates energy such as bipolar RF from the first pair of opposed electrodes to the second pair of opposed electrodes.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to and the benefit of U.S. ProvisionalApplications Nos. 60/884,719 filed on Jan. 12, 2007, 60/884,783 filed onJan. 12, 2007, and 60/973,552, filed Sep. 19, 2007. This applicationalso claims priority to, and is a continuation in part of, U.S.application Ser. No. 11/457,531 filed on Jul. 14, 2006, which claims thebenefit of U.S. Provisional Application No. 60/699,664 filed Jul. 16,2005. All of the above are hereby incorporated by reference in theirentirety.

BACKGROUND OF THE INVENTION

The present invention relates to medical/surgical instruments andsystems employing RF energy and/or monitoring or pacing devices andsystems and the use thereof. In a variety of medical procedures, it maybe desired to remove or cause the destruction of tissue, such as byablation. Some examples of such procedures include, without limitation,electrical isolation of cardiac tissue to treat atrial fibrillation,ablation of uterine tissue associated with endometriosis, ablation ofesophageal tissue associated with Barrett's esophagus, ablation ofcancerous liver tissue, and the like. The foregoing examples are merelyillustrative and not exhaustive.

In a number of the procedures in which tissue is ablated, it may bedesirable to have a sensing and/or pulse generating capability. Forexample, when ablating cardiac tissue to control or treat atrialfibrillation, it may be desired to apply electrical pulses to thecardiac tissue or to sense for the presence of electrical signals todetermine, for example, where the ablation should be carried out orwhether the ablation has been successful or fully transmural (completelythroughout the thickness of the tissue treated).

Because of the variety of functionalities of the devices that may beused in performing surgical ablation, a controller or “matrix router”may be advantageously used in the system to control the delivery of RFenergy and/or other electrical signals to the ablation instrument.

While a variety of techniques and devices have been used to ablate orcause lesions in tissue, and/or to sense or provide pulse generatingcapability, the present invention provides a unique and non-obviousadvance over prior devices and systems and offers unique utility notpreviously known or obvious.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims which particularly pointout and distinctly claim the invention, it is believed the presentinvention will be better understood from the following description ofcertain examples taken in conjunction with the accompanying drawings, inwhich like reference numerals identify the same elements and in whichvarious aspects and embodiments of the present invention areillustrated:

FIG. 1 is a schematic view of modules in an exemplary embodiment of amatrix router;

FIG. 1A is a schematic view of modules in an alternate exemplaryembodiment of a matrix router;

FIG. 2A illustrates a front panel of an exemplary matrix router;

FIG. 2B illustrates a rear panel of the matrix router of FIG. 2A;

FIG. 3A illustrates a front view of a first alternative matrix router;

FIG. 38 illustrates a rear view of the matrix router of FIG. 3A;

FIG. 4A illustrates a left side panel of the matrix router of FIG. 2A;

FIG. 4B illustrates a right side panel of the matrix router of FIG. 2A;

FIG. 5 illustrates a front view of a second alternative matrix router.

FIG. 6 illustrates a front view of a third alternative matrix router.

FIG. 7 illustrates a front view of a fourth alternative matrix router.

FIG. 8 is a schematic view of modules in an alternate exemplaryembodiment of a matrix router with frequency switching.

FIGS. 9 and 10 illustrate a front panel and rear panel, respectively, ofa fifth alternative matrix router.

FIG. 11 is a cross-sectional view of the matrix router of FIGS. 9 and10.

DETAILED DESCRIPTION OF THE INVENTION

The following description of the accompanying drawings are fordescription purposes only and should not be used to limit the scope ofthe present invention as set forth in the claims now or hereafter filed.Other examples, features, aspects, embodiments, and advantages of theinvention will become apparent to those skilled in the art from thefollowing description, which is by way of illustration, one of the bestmodes contemplated for carrying out the invention. Accordingly, thedrawings and descriptions should be regarded as illustrative in natureand not restrictive.

In some embodiments, a matrix router as described herein, might be usedto facilitate the performance of the Maze procedure through bipolarradio frequency (RF) ablation. As is well known to one of ordinary skillin the art, the Maze procedure is a procedure used to treat atrialfibrillation, a form of cardiac arrhythmia characterized by a loss ofsynchrony between the atria and ventricles of the heart. The Mazeprocedure treats atrial fibrillation through establishing conductionblocks in the heart which serve to stop the formation and conduction ofthe electrical patterns which are responsible for atrial fibrillation.When using bipolar radio frequency ablation to create the conductionblocks, a surgeon uses a device, such as a transpolar (or bipolar) pen(one type of which is disclosed in a U.S. patent application Ser. No.11/363,707 entitled “Surgical Ablation and Pacing Device” filed Feb. 28,2006, which is incorporated by reference, by way of example only), atranspolar (or bipolar) clamp (one type of which is disclosed in U.S.Pat. No. 6,517,536, which is incorporated by reference, by way ofexample only), or some other surgical device, to deliver bipolar radiofrequency energy to cardiac tissue.

As bipolar radio frequency energy is applied to tissue, the outer layersof the tissue may become non-conductive. As the outer layers of thetissue become non-conductive, the bipolar radio frequency energy maybegin to pass through deeper and deeper levels of tissue, untileventually the entire area of tissue selected by the surgeon has beenablated, creating a conduction block. Finally, to ensure that aconduction block has been successfully created, the surgeon might testthe electrical activity and response of the cardiac tissue usingtechniques such as pacing, stimulating and sensing. As is well known tothose of skill in the art, in this context, pacing refers to applyingelectrical impulses to cardiac tissue at a rate higher than thepatient's current heart rate (e.g., 10 to 20 beats per minute higher),stimulating refers to pacing which is performed at a relatively highrate and sensing refers to the process of monitoring the electricalactivity of tissue.

As an example of the use of the above techniques, a surgeon might pacethe tissue on the side of a conduction block which is opposite the heartchamber and observe the heart (for example, through visual observation,through observation of a electrocardiogram (ECG), or through some othermeans) to ensure that the pacing does not change the rate of thepatient's heart beat. As an example of the use of sensing, a surgeonmight use a tool such as an electrical sensor, to sense the electricalactivity of a patient's cardiac tissue to ensure that a fibrillatorysignal does not cross over a lesion formed by ablation. As an example ofstimulating, a surgeon might stimulate cardiac tissue and then observethe vagal (heart rate) response on an ECG. Of course, one or more ofthose techniques, or other techniques known to those of skill in theart, might be combined in order to verify that a conduction block hasbeen created. Additionally, it will be appreciated that this disclosuredoes not individually specify each testing technique that can be used,and will describe the use of a matrix router in terms of particulartechniques, such as pacing or sensing. As will be clear to one ofordinary skill in the art, the invention is not limited to the use ofthe techniques specifically set forth in the description, and othertechniques could be substituted for the techniques mentioned, withoutdeparting from the scope or spirit of the invention.

Because multiple pieces of equipment might be required for performing aMaze or other procedure, and those pieces of equipment might usedifferent radio frequency energy, or might use alternative types ofenergy entirely, it may be desirable for a piece of equipment, such asany of the matrix routers described herein, to allow the Integration ofsurgical devices and to allow multiple disposable devices to be drivenby a single piece of capital equipment without switching connectionsbetween devices. Further, one with ordinary skill in the art willrecognize that a matrix router may be utilized in contexts other thanperformance of the Maze procedure, such as ablation of uterine tissueassociated with endometriosis, ablation of esophageal tissue associatedwith Barrett's esophagus, ablation of cancerous liver tissue, and otherprocedures. Additionally, while the illustrative examples set forthbelow will generally discuss the performance of surgical proceduresusing bipolar radio frequency energy, it will be immediately apparent toone of ordinary skill in the art that a matrix router may be used withother types of energy, such as ultrasonic energy, mono-polar radiofrequency energy, microwave energy, laser energy, or other types ofenergy. Further, while the description of the Maze procedure set forthabove specifically mentions the use of certain tools such as atranspolar pen and a transpolar clamp, one of ordinary skill in the artwill immediately recognize that other ablation surgical devices might beused to perform the Maze procedure or other surgical procedures.Therefore, the examples presented herein discussing the use of a matrixrouter are intended to be illustrative only, and are not intended aslimiting on the scope of uses or configurations of the matrix router.

As schematically shown in FIG. 1, the matrix router (100) of the presentexample comprises an energy generator (101), a printer control module(102), a handpiece interface circuit (103), a pacing module (104), acontrol circuit (105), and an input/output circuit (106). As usedherein, the term “circuit” and variations thereof should be understoodto refer any type of electrical equipment, including programmable memoryand associated devices. Similarly, the term module should be understoodto refer to any portion of a device which performs at least onedelimited function, and possibly other functions. It will be immediatelyapparent to one of ordinary skill in the art that a module might beimplemented in circuitry, and that a single circuitry might containmultiple modules. One example of a circuitry which contains multiplemodules would be a circuitry comprising memory containing multiple setsof computer instructions wherein each set of computer instructions isdedicated to accomplishing a delimited function. Other module exampleswill be apparent to those of ordinary skill in theart.

For purposes of illustration, a discussion of how various components andmodules schematically depicted in FIG. 1 might operate and/or interactwith one another will be set forth. It should be understood that suchdiscussion is intended to be illustrative only of how certainembodiments might function, and is not intended to be limiting on thescope of the invention as a whole. In some embodiments, if a surgeonindicates a desire to use a transpolar pen with the matrix router (100)of this example, the handpiece interface board (103) will send a signalto the central processing board (105) notifying the central processingboard (105) that the surgeon wishes to use a transpolar pen in aparticular mode, for example, ablation mode. In response to receivingthat signal, the central processing board (105) triggers the energygenerator (101) or some external generator (not shown) to supplybi-polar radio frequency energy, which is then routed to the transpolarpen by the central processing board (105) through the handpieceinterface board (103). When the surgeon finishes using the transpolarpen for ablation, he or she might wish to verify the creation of aconduction block, which might be done by pacing. The matrix router {100)could facilitate the process of switching from ablation to pacingthrough a process comprising the step of sending a signal from thehandpiece interface board (103) to the central processing board (105),indicating that the transpolar pen should be used in pacing mode, ratherthan ablation mode. In response to receiving that signal, the centralprocessing board {105) activates the pacing module (104), andadditionally causes a connection between the pacing module (104) and thetranspolar pen to be established, so that the surgeon could test toverify the establishment of a conduction block. It should be understoodthat, in the context of this example, establishing a connection refersto establishing a logical connection over which signals can travel, anddoes not necessarily refer to the creation of an actual physicalconnection through the installation of wires between the pacing module(104) and the transpolar pen, though in some embodiments such a physicalconnection might be created, e.g., by closing a switch. Once the surgeonhad completed pacing, a signal is sent from the pacing module (104) tothe central processing board (105) indicating that the procedure wascomplete. The central processing board (105) then causes the printermodule (102) to create hard copy documentation of the procedure whichhad just been completed. Additionally, the central processing board(105) can use the input/output interface board (106) to send informationrelated to the procedure to some networked storage facility, includinglocal mass storage media for data retrieval.

FIG. 1A is a schematic diagram of an alternate matrix router (100A)which departs from the example of FIG. 1 by utilizing alternateconnections between modules (e.g., a direct connection between thecentral processing board (105) and the printer module (102), instead ofonly having those modules connected indirectly through the energygenerator (101) as was the case in FIG. 1. FIG. 1A also departs from theexample of FIG. 1 by incorporating a dedicated sensing module (107) inaddition to the pacing module (104) depicted in FIG. 1. It will beappreciated that such a sensing module (107) may, among other things,analyze signals obtained through a device (e.g., an ablation pen)coupled with the matrix router (100) to determine whether fibrillatorysignals are crossing over a lesion and/or to provide an indication as towhether the same is occurring. As will be clear to one of ordinary skillin the art, various other combinations and configurations of modulesbeyond those depicted in FIGS. 1 and 1A could be incorporated into amatrix router (100) without departing from the scope of spirit of theinvention.

FIGS. 2A and 2B illustrate the front and rear panels, respectively, ofan exemplary matrix router (200). The front of the matrix router (200)could be used by an operator, even an operator wearing typical surgicalgarb such as gloves, to switch between different handpieces (which mightbe disposable devices), and different functions, without necessarilyhaving to change handpiece connectors or utilize multiple pieces ofcapital equipment. The front of the matrix router (200) shown in FIG. 2Acomprises multiple interface ports (201) which may be used to establishconnections with disposable devices such as a transpolar clamp, atranspolar pen, or any other device. An interface port should beunderstood to include a location where a connection between one or moredevices and/or their constituent components can be established to allowelectrical or other signals (e.g., electric current) to pass to or from,or both, the device and/or their components. The matrix router (200)shown in FIG. 2A further comprises activity lights (202) over eachinterface port (201) which can be used to indicate whether thatinterface port (201) is currently active and/or for other purposes. Inaddition to the activity lights (202) over the interface ports (201),the matrix router (200) further comprises mode lights (203), which canbe used to indicate whether a device is currently operable in ablate orpace mode, though additional modes (e.g., stimulation mode, sensingmode, etc.) with corresponding mode lights might be utilized in someembodiments. The matrix router (200) further comprises an interfacebutton (205) and a mode button (204) which can be used to change whichinterface port (201) is active, or which mode a device is to be used in,respectively. An interface port (201) which is active should beunderstood to mean an interface port (201) which is receiving ortransmitting a signal from or to the matrix router (200). For example,if the interface button (205) was used to establish a connection betweenan energy generator and a first interface port (201), such that energyis being transmitted to a device through the first interface port (201),the first interface port (201) would be said to be active.

In one exemplary use, the matrix router (200) is coupled with atranspolar pen to perform the Maze procedure. Initially, the surgeoncould start by pressing the interface button (205) until the activitylight (202) over the interface port (201) for the transpolar pen is lit.Next, the surgeon could press the mode button (204) until the mode light(203) indicates that the transpolar pen is ready for use in ablationmode. Those lights (202, 203) being lit may signify that there is aconnection between an energy generator generating bipolar radiofrequency energy and the transpolar pen, and that the pen may thereforebe used in ablation mode. Referring to the schematic of FIG. 1, this maybe accomplished internally by circuitry comprising the handpieceinterface circuit (103), sending a signal to the control circuit (105),requesting a connection be established between the appropriate interfaceport (201) and an energy generator for generating bipolar radiofrequency energy, which might be the energy generator (101), or might besome external generator or other energy source (not shown in FIG. 1).Alternatively, a matrix router (200) could be implemented as amechanical device wherein the interface of FIG. 2A would establishconnections between handpieces and the appropriate energy generators,and the matrix router (200) would remain passive, acting only as apass-through for signals between the energy generators and handpieces.Further, some embodiments might function using a combination ofcircuitry and mechanical switches.

While the surgeon is using a transpolar pen to ablate cardiac tissue,the actual amount of bipolar radio frequency energy delivered by the pencan be controlled by operational logic circuitry in the control circuit(105) which can deliver a trigger signal to the energy generator (101)to determine a power generation curve to follow as appropriate for theactive device (various power generation curves and methods for selectingthem are disclosed in U.S. patent application Ser. No. 11/037,810, filedJan. 18, 2005, the teaching of which is incorporated by referenceherein), or by some external RF generator (not shown). As used herein,an operational logic circuitry should be understood to mean circuitrywhich specifies one or more outputs on the basis of one or more giveninputs. Alternatively, the device being used to ablate tissue, in thiscase a transpolar pen, can itself generate an identification signalindicating an appropriate power generation curve, that signal beingtranslated through the matrix router (200) to the energy generator (101)or some external RF generator, in which case the matrix router (200)might act as a simple pass-through. In some embodiments, an energygenerator (101) or an external RF generator can include variousoperational logic circuitries which would supply power for anappropriate power generation curve, the power generation curve beingdetermined by the identification signal. For example, there can be twodefined power generation curves, in which case the energy generator(101) or an external RF generator could contain two operational logiccircuitries, one for each power generation curve. Other suitableconfigurations will be apparent to those of ordinary skill in the art.

Once the surgeon has finished creating a conduction block, he or shemight use the pacing module (104), sensing module (107), or othermodules which can be incorporated into the matrix router (200) to verifythat the tissue making up the block could not transmit electricalsignals introduced by pacing the tissue. The matrix router (200)facilitates this switching from ablation to pacing through the use ofthe mode button (204). Specifically, when the surgeon has finishedablation, he or she simply presses the mode button (204), or requeststhat an assistant press the mode button (204), and the matrix router(200) will switch the transpolar pen from ablation mode to pacing mode.The matrix router (200) as shown in FIG. 2A provides visual confirmationthat the transpolar pen was in the proper mode by extinguishing the modelight (202) indicating ablation, and illuminating the mode light (202)indicating pacing. Referring to the schematic of FIG. 1, mode switchingcan be accomplished internally by the handpiece interface board (103)establishing a connection between the isolator transpolar pen and thepacing module (104), which would provide electrical signals to stimulatethe cardiac tissue, and may further analyze the response detected by thetranspolar pen. Additionally, the handpiece interface board (103) orpacing module (104) could also command the control circuit (105) toestablish a connection between some external pacing module (not shown inFIG. 1), and the handpiece interface board (103).

While the front side of the matrix router (200) can be used to providean interface for a surgeon to switch between different devices anddifferent modes, the back of the matrix router (200), as shown in FIG.2B, could be utilized for other purposes. For instance, the back of thematrix router (200) of this example has an on/off switch (206), togetherwith an input (207) for connecting the matrix router with an externalenergy source (e.g., a standard wall outlet). The matrix router (200) ofthis example further comprises a serial input/output port (208) and aUSB input/output port (209) (though some embodiments might includemultiple serial input/output and/or USB input/output ports) which couldbe used for data transmission, connecting additional devices, or otherpurposes. The functionality of those components could be useful forsurgery, for example to transmit reports of the procedure, or to createdata archives. The matrix router (200) further comprises an interface(210) for an ablation and sensing unit (ASU), which is a piece ofcapital equipment capable of producing or regulating energy for ablationof tissue and might additionally include operational logic circuitriesfor following specific output functions for power generation, or providesensing of various electrical parameters, among other features.

While FIGS. 1, 2A, and 2B depict a schematic of the internal workingsand interfaces of an exemplary matrix router (200), those figures areintended to be illustrative only, and numerous modifications andvariations of the matrix router (200) will be immediately apparent toone of skill in the art. For example, while the example of using amatrix router (200) to facilitate performance of the Maze procedureincluded a surgeon switching between handpieces using an interfacebutton (205), other embodiments might expand on the handpiece interfacecircuit (103) of FIG. 1 to enable the matrix router (200) toautomatically detect what device is being used by a surgeon, andestablish a connection between that device and the appropriate capitalequipment (such as the ASU) without needing to be directed by a surgeonusing an interface button (205). For instance, the handpiece interfacecircuit (103) may automatically detect the coupling of a device to anyinterface port (201) and/or detect the type of device coupled to aninterface port (201). Further, it will be appreciated that any othertypes of data connection may be provided in addition to or in lieu ofthe serial input/output port (208) and the USB input/output port (209)depicted in FIG. 2B. For example, in addition to, or as an alternativeto, the ports (208, 209, 210) depicted in FIG. 28, a matrix router (200)might have a firewire communications port or a port for a mass storagedevice such as a flash memory element as well as a wirelesscommunication media. It will be apparent to one of ordinary skill in theart that such ports may be added to the matrix router without departingfrom the spirit or scope of the invention. Other variations will beapparent to those of ordinary skill in the art.

FIGS. 3A and 3B show an alternative matrix router (300). In thisexample, all the components shown in FIGS. 2A and 2B are present, butadditional components, such as a liquid crystal display (LCD) screen(301), a power indicator (302), a keyboard (303), and an input (304) foran ECG and/or esophageal probe or other type of diagnostic or other typeof device have been added. In order to illustrate the use of theseadditional components, consider again the scenario of a surgeonperforming the Maze procedure. Using the matrix router (300) the surgeoncould follow the procedure outlined above for FIGS. 2A and 2B, but couldadditionally utilize an ECG, through the input (304) for monitoring thepatient's heartbeat to ensure that the procedure was successful.Additionally, the surgeon could use the LCD screen (301) to monitor theECG, avoiding the necessity of having a separate piece of displayequipment. The slide out keyboard (303) would allow the surgeon (or anassistant, as appropriate), to input data such as patient demographicsand/or physical characteristics into the matrix router (300). Theseadditional data sources, the keyboard (303) and the input (304) mayallow a more complete picture of the operation to be created, whichcould be archived using the serial input/output port (208) or the USBinput/output port (209). The entered information can also be printed andhardcopy made available for patient record. Additionally, the keyboard(303) might be used for system configuration or other purposes, whilethe LCD screen (301) could be used for data presentation, in addition tosimply displaying the ECG output. The power indicator (302) of thisexample comprises a light that is illuminated when the matrix router(300) is drawing power from an energy source (not shown). Matrix router(300) further comprises legs (305) which would allow the matrix router(300) to be placed on top of another piece of equipment, such as an ASU,without interfering with the use of the slide out keyboard (303).

As with FIGS. 1, 1A, 2A, and 28, FIGS. 3A and 3B are intended to beillustrative only of certain components which could be added to a matrixrouter (300) in addition to those shown in FIGS. 2A and 28. Variousmodifications and alterations to the components shown in FIGS. 3A and 3Bwill be immediately apparent to one of ordinary skill in the art. Forexample, the LCD screen (301) of FIG. 3A could be replaced with analternative display technology, such as a cathode ray tube (CRT)monitor, or a plasma screen monitor, or could even be moved out of thematrix router all together, and replaced with a connection to anexternal graphic display device. Similarly, it will be immediatelyapparent to one of ordinary skill in the art that, instead of having aninput to an external ECG or other diagnostic device (304), an internalECG or other diagnostic device could be integrated into the matrixrouter itself. Thus, it should be understood that FIGS. 3A and 3B, likethe figures which preceded them, are intended to be illustrative only,and not limiting.

FIGS. 4A and 4B illustrate side views of the exemplary matrix router(200) of FIGS. 2A and 2B, with FIG. 4A illustrating a left view, andFIG. 48 illustrating a right view. In this embodiment, the sides of thematrix router (200) are used for input and output ports. For example,the left view of FIG. 4A includes a printer module (401), which could bea thermal printer or other type of printer integrated with the matrixrouter (200). The printer module (401) could be used to provide hardcopy confirmation and documentation of procedures which were performedutilizing the matrix router (200). Other information suitable forprinting by printer module (401) will be apparent to those of ordinaryskill in the art. In the right view of FIG. 4B, there is both aninterface (402) for a cable connected to an ASU or other device, andports (403) for a connection to an alternative external energy or datasource. Matrix router (200) may further comprise additional buttons orother features for switching between energy or data sources, in the samemanner as the interface button (205) shown in of FIGS. 2A and 3A allowsswitching between multiple handpieces. Indeed, in some embodiments,there might be only a single interface port (201), which may allowmultiple pieces of equipment, such as different generators, to drive asingle disposable device, such as a transpolar pen. In one embodiment, afoot switch (not shown) is coupled with the matrix router (200) toinitiate delivery of RF energy as an example. Such a foot switch couldbe used to substitute or supplement the interface button (205), the modebutton (204), and/or provide any other suitable features. In yet anotherembodiment, a substitute or supplement for the interface button (205)and/or the mode button (204) is provided in a surgical device (notshown) coupled with the matrix router (200). In this embodiment, thematrix router (200) is operable to detect selections made by such afeature on the surgical device, and is configured to provide a signal tothe surgical device in accordance with such selections.

FIG. 5 shows a front view of another alternative matrix router (500). Inthis example, the interface and mode buttons (204, 205) shown in FIGS.2A and 3A have been replaced with a single selection dial (501) which isoperable to control which interface port (201) is to be connected to anASU (not shown) or to another device. Additionally, the matrix router(500) of this example includes pictorial indications (502) of devicesfor each interface port (201), increasing the convenience of using thematrix router (500). The matrix router (500) further comprises aninterface (503) for connecting a cable (504) to an ASU, as well asadditional ports (505) for connecting an additional external powersource or other external device. In this way, matrix router (500)combines the interface functionality illustrated in FIGS. 2A and 3A,with the power interface components shown in FIG. 4B.

FIG. 6 shows a front view of another alternative matrix router (600)having many of the features described in relation to previous diagrams,such as a selection dial (501), interface ports (201), an interface(503) for connecting to an ASU, as well as other ports (505) forconnecting to additional external power sources or other externaldevices. However, while there are similarities between the matrix router(600) depicted in FIG. 6 and those depicted previously, there are alsosome differences. One such difference is that, the matrix router (600)depicted in FIG. 6 includes two additional ports (505) for connecting toadditional external power sources or other external devices. Thoseadditional ports (505) could be used to simplify the performance ofprocedures which utilize additional pieces of external equipment. Forexample, in the matrix router (600) of FIG. 6, a dedicated ablation unitcould be connected to the interface (503), and separate pacing andsensing units could be connected to the additional ports (505). Whenutilizing the pacing or sensing units, the surgeon could switch to theappropriate additional port (505) using the switch (601) between thoseports (505). This might simplify workflow by allowing a surgeon toalternate between multiple pieces of additional equipment (the pacingand sensing units) by using a switch (601) rather than by disconnectingone piece of equipment so that the other could be connected to thesingle additional port (505). Of course, as will be apparent to one ofordinary skill in the art, the invention is not restricted to thenumbers or configurations of ports depicted in the diagrams, and someembodiments of the invention will include matrix routers with moreports, or ports in alternate configurations, or both. For example, FIG.7 depicts a matrix router (700) in which switching between additionalports (505) is performed using a selection dial (501) rather than with adedicated switch as in FIG. 6.

While FIGS. 5-7 demonstrate one particular alternate means of switchinghandpiece connections, the selection dial (501), it will be apparent toone of ordinary skill in the art that there are many additionalfeatures, such as levers, sliders, switches, etc., which could be usedto select handpiece connections. Further, it will be immediatelyapparent to one of ordinary skill in the art that various othercomponents, such as a modem which could be used for remote systemdiagnostics or data transmission, or a fax which could be used for localtransmission of full disclosure, could easily be added to a matrixrouter (200, 300, 500, 600, 700) and that such augmented matrix routersare well within the scope of the invention. Further, one of ordinaryskill in the art will immediately recognize that virtually any componentof a matrix router (200, 300, 500, 600, 700) could be integrated intothe matrix router (200, 300, 500, 600, 700) itself, or could be attachedto the matrix router (200, 300, 500, 600, 700) via an interface port. Toillustrate this option, the following table sets forth componentconfigurations for a number of embodiments, and also indicates thatdifferent embodiments might have different combinations of integratedand externally provided components.

TABLE 1 Handpiece Switching Handpiece Handpiece Switching HandpieceSwitching with External Pace, Switching With With Integrated HandpieceHandpiece Switching with External Pace, Sense, and Stimulate InputIntegrated Pace, Pace, Sense, Switching with External Sense, andStimulate Sources plus Sense, Stimulate Stimulate Circuits Only PaceInput Source Input Sources Communication Circuits plus CommunicationTranspolar E E E E E E Clamp Transpolar Pen E E E E E E Pace Module E EE X X Stimulate E E X X Module Patient ECG E E E X X Thermal Printer X XX X X Graphical X X Display/KB Modem X X Mass Storage X X E = Externallyprovided to the matrix router. X = Integrated with the matrix router.

Of course, the configurations shown in Table 1 are merely exemplary.Still other ways in which features may be allocated integrally andexternally will be apparent to those of ordinary skill in the art.

In addition to simplifying the use of various surgical devices as setforth above, certain embodiments of the matrix router (200, 300, 500,600, 700) might additionally be configured to automatically document theuse of the matrix router (200, 300, 500, 600, 700). For example, in someembodiments, the matrix router (200, 300, 500, 600, 700) mightautomatically compile a record of which interfaces and/or which modeswere activated throughout the course of a surgical procedure. Similarly,in some embodiments which include data inputs, such as an ECG, thematrix router (200, 300, 500, 600, 700) might automatically compileinformation provided by those data inputs as well. Such data compilationmight be further integrated with data provided through the keyboard, ormight be used as an additional or alternative source of documentationfor a surgical procedure.

One advantage accruing to the matrix router described in the presentapplication is that switching can be configured so that one or moreinterface ports is active at the same time. For example, the switchingcan be configured so that when a transpolar clamp interface port isactivated for ablation, the interface port for the transpolar pen issimultaneously activated so that the transpolar pen can be used onlyfor, e.g., sensing or pacing (but not for ablation). Using the pen forsensing would allow monitoring the progress of ablation and theconfirmation of the creation of a transmural (i.e., isolating) line ofablation in real time by means of a intracardiac recording systemconnected to one of the auxiliary interface ports (505) (“PSS ports”),an electrical pathway being established between the PSS port and thetranspolar pen port (and an RF energy pathway to the pen being disabled)whenever a clamp port is selected.

Thus, as an example, with the selection dial activating a clampinterface port, a procedure may be performed in which an ablation clampis located around the pulmonary veins for making an electricallyisolating line of ablation. The pen is placed in contact with the heartadjacent to the clamp on the pulmonary vein side of the clamp, and abaseline reading of the cardiac (electrical) potential is taken.Ablation with the clamp commences with the pen continuing to be incontact with the cardiac tissue so as to receive, in real time as theablation is taking place, a signal corresponding to the cardiacpotential. The signal is simultaneously displayed and recorded by therecording system attached to the PSS port. Thus, confirmation of thecreation of an isolating lesion can be seen in real time as the cardiacpotential, measured by the pen, attenuates and vanishes with thecreation of a fully transmural lesion.

Alternatively, or additionally, a pacing unit may be connected to one ofthe PSS ports. The transpolar pen may then be used to apply apacing/stimulation signal to the heart at a rate different from thepatient's normal heart rate. Then, by observation of a separate EKGmonitor, or by observation of the patient's beating heart, transmuralityof the lesion can be confirmed, in real time, by the attenuation andvanishing of the effect of the pacing signal and the resumption of thepatient's normal cardiac rhythm.

The foregoing are intended to be illustrative, and not limiting, of thetypes of procedures that may be performed with the matrix router of thepresent invention in which multiple of the interface ports aresimultaneously activated.

FIG. 8 shows a diagram of yet another alternate embodiment, whichcomprises a switching matrix router (800). The switching matrix router(800) can comprise many of the features described above and shown in theprevious Figs., such as an energy source (801) which can supply energysuch as bipolar RF energy, a printer control module (802), a handpieceinterface circuit (803), a pacing module (804), a control circuit (805),an input/output circuit (806), and a sensing module (807). For thisalternate embodiment, handpiece interface board (803) can comprise aplurality of 1/0 ports for the connection of surgical devices to theswitching matrix router (800). The plurality of 1/0 ports can include anASU port (809) for connection of the ASU, an AUX 1 1/0 port (810) forconnection of a first auxiliary device such as a sensing or pacing unit,an AUX 2 1/0 port (811) for connection of a second auxiliary device suchas a sensing or pacing unit, a pen RF 1/0 port (812) for connection to aRF pen, a single RF 1/0 port (813) for the connection to a surgicaldevice having a single pair of opposed bipolar electrodes, and a twin RF1/0 port or paired electrode interface port (814). The paired electrodeinterface port (814) could be provided for the connection of a pairedelectrode device (815} to the switching matrix router (800). Such a dualpaired electrode device is shown in U.S. Provisional Application No.60/884,783, filed Jan. 12, 2007 and incorporated by reference above. Thepaired electrode device (815) can have at least two pairs of bipolarelectrodes such as a first pair of opposed electrodes (816, 817) and asecond pair of opposed electrodes (818, 819) shown opposed on oppositesides of a portion of tissue (820). The paired electrode device (815)can have one wire extending from each electrode (815, 816, 817, 818) toelectrically connect the electrodes to the electrode interface port(814). The pairs of electrodes (816, 817) and (818, 819) may beopposably mounted in a clampable portion of the paired electrode device(815), such as a first jaw and a second jaw, and one or both of the jawscan be moved together to clamp tissue (820) between the jaws andelectrodes (816, 817) and (818, 819). Energy can be applied to theclamped tissue 820 across the first electrode pair (816, 817) and acrossthe second electrode pair (818, 819). The application of energy such asbipolar RF energy to the clamped tissue (820) can cauterize the clampedtissue.

In FIG. 8, the paired electrode device (815) is shown as having theelectrodes (816, 817, 818, 819) spaced on two sides of the tissue (820).The electrode pairs (816, 817) and (818, 819) can be spaced apart anamount such as space (835), and, by way of example, the electrode pairscould be located parallel to one another.

Whereas the above description describes the application of energy acrossthe first pair of opposed electrodes (816, 817) and across the secondpair of opposed electrodes (818, 819), one or more additional pairs ofelectrodes spaced from the first and second pairs may be provided, withenergy being selectively applied to tissue through the additionalelectrode pairs.

More specifically, the paired electrode device (815) can have “n”-numberof pairs of opposed electrodes, where “n” is a number or integer that istwo or greater, such as 2, 3, 4, . . . or more. For such an electrodeconfiguration, the paired electrode interface port (814) can have a likenumber of electrical connections for each of the “n”-number of pairs.The selection of the electrode pairs can be electrical, mechanical, orany combination thereof. For example, an electrical circuit such as theelectrode pair selector (845) could be operably coupled to the pairedelectrode interface port (814) to select any desired combination ofpaired electrodes. This selector (845) can be operator selected, anautomatic selection, a pre-set selection, or pre-programmed selection.Selection can also occur anywhere, for example, by having the electrodepair selector (845) in the switching matrix router (800) or in thesurgical device such as paired electrode device (815). This electrodepair selector (845) could, in one embodiment, be a circuit that canrecognize a surgical device such as the paired electrode device (815)and select an appropriate combination of pairs of electrodes for thatdevice. The electrode pair selector (845) can be located, for example,anywhere between the electrodes and the power supply (801), including,but not limited to, on the handpiece, the connector, and the box for therouter. The electrode pair and polarity selector (845) can also bemechanical, electrical or electromechanical such as a switch, aconnector, or a jumper. For example, the electrode pair selector (845)could be as simple as an electrical connector on the ends of a pluralityof electrode wires extending from the paired electrode device (815) andelectrode selection can be the order in which they are plugged into aplurality of mating 1/0 connectors in the electrode interface port(814). Thus, for example, simply unplugging one combination of theelectrode wires from the fixed connectors in the paired electrodeinterface port (814), and re-plugging different electrode wires intodifferent connectors in the paired electrode interface port (814) canselect new electrode pair combinations. Other combinations of four wiresand four connectors can be selected for different electrodeconfigurations for the electrode pair selector (845), however theselector (845) is not limited to that particular embodiment.

A module or paired electrode frequency switching device (830) can beelectrically connected between the energy source (801) and the pairedelectrode interface port (814), and can operate with any connectedembodiment of the paired electrode device (815) described above. Whenthe paired electrode device (815) is connected to the paired electrodeinterface port (814), and energy is supplied from the energy source(801), the frequency switching module (830) may rapidly alternate orswitch delivery of energy such as bipolar RF energy back and forthbetween any selected combination of electrode pairs and polarities at aswitching frequency. With a paired electrode device (815) shown havingtwo pairs of opposed electrodes, the alternating delivery of energy at aswitch[ng frequency can be timed to energize only one electrode pair ata time. As the electrode pairs are switched, the switching from thefirst pair to the second pair may be about instantaneous or nearinstantaneous. Alternately, by way of example, a slight pause or delayin the delivery of energy to the electrodes could occur slightly beforethe electrode pair switch, and/or during the switch, and/or slightlyafter the electrode pair switch. This delay between switching, forexample, could be about 150 pseconds. Alternately, by way of example,whenever the paired electrode frequency switching module (830) isactuated or energy is being delivered, delivery of RF energy can beensured to at least one pair of the selected electrode pairs such aspairs (816, 817) and (818, 819). In another alternate embodiment, thepaired electrode frequency switching module (830) can preventsimultaneous power delivery to all electrode pairs.

In a further embodiment, the frequency switching matrix router (800)and/or switching module (830) can contain internal circuitry and logicto meet the switching needs of any embodiment described, or switchingcan be driven or controlled by an external device such as, but notlimited to, the ASU. An ASU port (809) is provided to deliver power orsignal from the ASU to the frequency switching module (830) and/orpaired electrode device (815).

The paired electrode frequency switching module (830) may provide anyone or any combination of switching frequencies. The appropriatefrequency for a paired electrode device (815) can be selected as afunction of surgical device and/or system parameters. These surgicaldevice parameters can include, but are not limited to: spacing of theelectrode pairs (816, 817) and (818, 819), the length of the electrodes,the RF power level with respect to tissue impedance, and the springrate/compression force of the jaws holding the electrode pairs clampedon tissue. Selection of the appropriate frequency can be accomplished ina variety of ways through a frequency selector (818), which can be amanual switch such as a dial switch, a dip switch, jumpers, or a pairedelectrode device (815) recognition circuit using logic and/or surgicaldevice recognition within the switching matrix router (800) or ASU. Forexample, the frequency selector (825) can identify the paired electrodedevice (815) and can select a switching frequency for that specificdevice. Such recognition could occur when the surgical device such asthe paired electrode device (815) is electrically connected to thepaired electrode interface port (814), and both device detection andfrequency selection can be driven by the switching matrix router (800)or by the ASU. Alternately, the frequency selector (818) can be aportion of a surgical device such as paired electrode device (815).

Switching frequencies of the frequency switching module (830) can bebetween but are not limited to about 2 Hz and about 575 Hz. In anotherexample, a frequency for a surgical device can range between 1O Hz toabout 376 Hz. Alternately, in yet another embodiment, the frequency or afrequency range can be any selected from TABLE 2.

TABLE 2 Switching Frequency Selections (Hz) Selection No. Nominalfrequency Frequency Range  1 523 471-575  2 467 421-513  3 417 376-456 4 367 331-403  5 337 304-370  6 267 241-293  7 213 192-234  8 157142-173  9 113 102-124 10 77 70-84 11 53 48-58 12 43 39-47 13 33 30-3614 27 25-29 15 21 19-23 16 11 10-12 17 5 1-9

In addition to controlling and selecting the frequency, the pairedelectrode frequency shifting device (830) can be used to control theduty cycle for at least one of the pairs of the opposed electrodes. Inan example, the paired electrode frequency shifting device (830) canalternate the energy between the respective pairs of electrodes at aduty cycle of less than 100% for each pair of electrodes.

Alternately, from a system level, the paired electrode frequencyswitching device (830) can be placed at any point between the energysource (801), and the paired electrodes such as the first pair ofopposed electrodes (816, 817) and the second pair of opposed electrodes(818, 819).

While the matrix router and surgical device have been described as autilizing bipolar RF energy, other energy sources may be utilized suchas ultrasonic energy, mono-polar radio frequency energy, microwaveenergy, laser energy, or other types of energy. The surgical device canhave n-number of paired (for bipolar application) or individual (forunipolar application) sets of ablation energy delivery surfaces (such aselectrodes when, e.g., RF energy is used) where n is greater than 2, andeach electrode pair or active surface can cauterize tissue clampedtherebetween or placed thereupon with any of the energies describedabove. In an embodiment, the alternate frequency switching matrix routercan include a switching module that can alternate delivery of any energyto the n-numbered paired energy delivery surfaces of the alternatesurgical device.

As described above, the matrix router includes an interface button (205)or a selection dial (501) on the front panel for establishing aconnection between the energy generator and the desired interface ports(e.g. interface ports (201) and (505)). In a typical operating room,access to the front panel of the matrix router to manipulate theinterface buttons/selection dial may be impeded due to limited space forpersonnel within the sterile field. Accordingly, in keeping with anotheraspect of the invention, the matrix router may be provided with a secondinterface button/selection dial on the rear panel that is operativelyconnected to the button/dial on the front panel. This permits thebutton/dial to be manipulated from either the front or rear panel toselectively connect the desired interface ports to the energy generatoror other peripheral devices.

With reference to FIGS. 9 and 10, the front and rear panels (902, 904,respectively), of a matrix router (900) are shown, each having aselection dial ((906) for the front panel and (908) for the rear panel).The selection dials (906, 908) are operatively connected so that theyoperate in tandem, regardless of whether the port selection is made withthe selection dial (906) on the front panel (902) or the selection dial(908) on the rear panel (904). The front and rear panels (902, 904) alsohave markings or other visual indications of the interface port or ports(912) that are selected. The visual indication may be in the form ofgraphics on the panel and a pointer (914) on the selection dial (906,908), as is shown in the illustrated. embodiment. Other visualindicators are also contemplated, such as lights. Regardless, the samevisual indication is provided to a person viewing the rear panel as isprovided to a person viewing the front panel.

The operative connection between the buttons/dials on the front paneland the rear panels may be mechanical, such as through an articulatedlinkage (916) directly connecting the front dial (906) and the rear dial(908) (as shown in FIG. 11). Alternatively, the front and rear selectorsmay be connected electronically. The port selection may also becontrolled by a remote control handpiece.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

1. A surgical router for connecting one or more surgical devicesthereto, the surgical devices including a paired electrode device of thetype having at least a first pair of opposed electrodes and a secondpair of opposed electrodes for clamping and cauterizing tissuetherebetween, the surgical router comprising: a) an energy sourceoperable to power a plurality of surgical devices; b) an interface portoperably connected to the energy source, comprising a paired electrodeinterface port for the connection of a paired electrode device thereto;and c) a switching device operably connected between the energy sourceand the paired electrode interface port, wherein when the pairedelectrode device is operably connected to the paired electrode interfaceport, the switching device alternates energy from the first pair ofopposed electrodes to the second pair of opposed electrodes at aswitching frequency.
 2. The surgical router of claim 1, wherein theswitching frequency of the switching device is selected with a frequencyselector.
 3. The surgical router of claim 2, wherein the frequencyselector is at least one switch.
 4. The surgical router of claim 2,wherein the frequency selector is at least one jumper.
 5. The surgicalrouter of claim 2, wherein the frequency selector is in the pairedelectrode device.
 6. The surgical router of claim 2, wherein thefrequency selector is a circuit that recognizes any one of a pluralityof paired electrode devices and can select a frequency for any one ofthe paired electrode devices.
 7. The surgical router of claim 2, whereinthe frequency selector selects a switching frequency as a function of aspacing between the each pair of opposed electrodes of the pairedelectrode device.
 8. The surgical router of claim 2, wherein thefrequency selector selects a switching frequency as a function of thelength of the electrodes of the paired electrode device.
 9. The surgicalrouter of claim 1 wherein a member of each pair of opposed electrodes islocated in one jaw of a pair of clampable jaws and the switchingfrequency selected by the frequency selector is a function of an RFenergy power level with respect to an impedance of the tissue clampedbetween the each pair of opposed electrodes.
 10. The surgical router ofclaim 2, wherein when the first pair of opposed electrodes and the.second pair of opposed electrodes of the paired electrode device areclamped on tissue, the frequency selector selects a switching frequencyas a function of an energy power level provided by the energy sourcewith respect to an impedance measured across the tissue clamped betweenthe pairs of opposed electrodes.
 11. The surgical router of claim 2,wherein a member of each pair of opposed electrodes are located in onejaw of a pair of clampable jaws and the switching frequency selected bythe frequency selector is a function of a spring rate and the clamppressure exerted on the tissue clamped between by the clampable jaws.12. The surgical router of claim 2, wherein when the first pair ofopposed electrodes and the second pair of opposed electrodes of thepaired electrode device are clamped on tissue, the switching frequencyselected by the frequency selector is a function of a spring rate ofportions of the paired electrode device that both mount the opposedelectrode pairs and exert a clamping pressure onto the tissue.
 13. Thesurgical router of claim 1, wherein any combination of the electrodepairs can be selected for the paired electrode device. 14.-15.(canceled)
 16. The surgical router of claim 1, wherein when energy isbeing delivered, the switching device prevents energy from being aboutsimultaneously delivered to each respective pair of opposed electrodesof the paired electrode device.
 17. The surgical router of claim 1,wherein when energy is being switched from one electrode pair to theother, the energy delivery to the selected electrode pair can be delayedfrom about just before the switch to just after the switch.
 18. Thesurgical router of claim 1, wherein energy is delivered at any giventime during activation of the router, to at least one pair of opposedelectrodes of the paired electrode device.
 19. The surgical system ofclaim 1 wherein the switching device alternates the energy between therespective pairs of electrodes at a duty cycle of less than 100% foreach pair.
 20. The surgical router of claim 1, wherein the switchingfrequency is between about 10 Hz and about 376 Hz. 21.-22. (canceled)23. A surgical system for delivering energy to tissue comprising: a) anenergy source operable to deliver energy; b) a surgical devicecomprising two or more pairs of opposed electrodes operably connected tothe energy source and clampable on tissue, the electrodes having alength and the pairs of electrodes being spaced from each other; and c)a switching device operably coupled between the energy source and therespective pairs of opposed electrodes, wherein when energy is deliveredto tissue clamped between the two or more pairs of opposed electrodes,the switching device alternates energy to each pair of opposedelectrodes at a switching frequency. 24.-49. (canceled)
 50. A switch boxfor selectively connecting medical devices to a power source comprisingthree or more inputs adapted for physically connecting the medicaldevices to the switch box; an actuator for selectively electricallyconnecting a selected input to a power source or a selected one of theother inputs, the selection of a first input to a power source causingthe simultaneous selection of a second input to a third input andde-activation of the second input relative to the power source.